Mid-urethral synthetic slings in the treatment of urodynamic female stress urinary incontinence without concomitant pelvic prolapse repair: 4-year health-related quality of life outcomes

Study Type - Therapy (outcomes research) Level of Evidence 2c Objective To report 4-year health-related quality of life (HRQL) outcome data after retropubic mid-urethral synthetic sling (MUS) surgery without concomitant prolapse repair for treating female stress urinary incontinence (SUI) in a single institution. Patients and Methods The data were prospectively collected, which yielded 21 consecutive patients with a mean (range) age of 67.6 (41-81) years who underwent retropubic MUS with ≥4 years follow-up. Before surgery, all patients underwent history, examination, pad usage, and multichannel fluoroscopic urodynamics according to International Continence Society standards. In all, 19 patients had urethral hypermobility with an abdominal leak-point pressure (ALPP) of >90 cmH₂0 and two had intrinsic sphincter deficiency with an ALPP of <60 cmH₂0. The MUS were all placed under no tension. All patients were cystoscoped with both 30 and 70° lens at the end of the procedure with a fully distended bladder to exclude bladder or urethral injury. The validated Kings Health Questionnaire (KHQ) was used both before and after surgery to assess HRQL measures. All patients were assessed at 3 months, and then at least three times thereafter. Results The paired Student's t-test was used on the mean KHQ scores before and after MUS surgery (4 years follow-up). There were statistically significant improvements in all nine domains on the KHQ between preoperative and 3 months after MUS surgery (P < 0.01), with the most significant being in 'General Health Perceptions', 'Incontinence Impact', 'Physical Limitations', and 'Role Limitations'. Improvement in HRQL persisted up to 4 years in all domains. Bladder perforation occurred in two patients with uneventful resolution. Two patients required very short-term catheterization (<5 days). In the present series, there was no sling revision, division, infection or erosion. No patients developed de novo urgency or urge UI after MUS surgery. The pad-free rate in the present series was 85.7%. Conclusion In our institution, HRQL improvement at 3 months after retropubic MUS surgery predicts persistence of improvement at 4 years. This is useful clinically in counselling our patients for treatment efficacy. Tension-free placement is associated with minimal risk of postoperative retention or de novo overactive bladder. Although patient numbers are modest, these data contribute to the scarce longer term (≥4 years) HRQL data on the MUS, which is a safe and durable procedure with a minimal complication profile.